Impulse Control Disorder

Impulse control disorders (ICDs) are common psychiatric conditions in which affected individuals typically report significant impairment in social and occupational functioning, and may incur legal and financial difficulties as well. Despite evidence of ICDs being fairly common, they remain poorly understood by the general public, clinicians, and persons with the disorders. Pharmacotherapy studies, although limited, have demonstrated that some ICDs respond well to treatment; however, there has been either very limited or, for some ICDs, no research into potential treatments. In addition, further research is needed to substantiate many of the studies that have been conducted.

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Formal ICDs include pathological gambling (PG), kleptomania, trichotillomania (TTM), intermittent explosive disorder (IED), and pyromania; these disorders are characterized by difficulties in resisting urges to engage in behaviors that are excessive and/or ultimately harmful to oneself or others.1 Diagnostic criteria have also been proposed for other disorders categorized as ICDs not otherwise specified (NOS) in DSM-IV-TR: pathological skin picking (PSP), compulsive sexual behavior (CSB), and compulsive buying (CB). ICDs are relatively common among adolescents and adults, carry significant morbidity and mortality, and can be effectively treated with behavioral and pharmacological therapies. The purpose of this review is to provide a clinical picture of these ICDs, including co-occurring psychiatric conditions (Table 1), and to review the evidence for the pharmacological treatment of these disorders (Table 2).

Core characteristics of impulse control disorders

Although the extent to which ICDs share clinical, genetic, phenomenological, and biological features is not completely understood, many ICDs share core qualities: (1) repetitive engagement in a behavior despite adverse consequences; (2) diminished control over the problematic behavior; (3) an appetitive urge or craving state prior to engagement in the problematic behavior; and (4) a hedonic quality experienced during the performance of the problematic behavior.2 These features have led to a description of ICDs as behavioral addictions.

ICDs also appear to have some clinical overlap with compulsive behaviors although this relationship is not yet completely understood. The domains of impulsivity (defined as a predisposition toward rapid, unplanned reactions to either internal or external stimuli without regard for negative consequences)3and compulsivity (defined as the performance of repetitive behaviors with the goal of reducing or preventing anxiety or distress, not to provide pleasure or gratification)1 have been considered by some as lying at opposite ends of a spectrum. Compulsivity and impulsivity may, however, occur simultaneously in a disorder or at different times within a disorder, thereby complicating both our understanding and treatment of certain behaviors.